06090063i3 LICENSED CONTRACTOR'S DECLARATION
i= J hereby affirm thai I am licensed under provisions of Chapter 9 (commencing Job Description
~ with Section 7000) or Division 3 or the Business and ProCessions Code. and my licensc is
fn in. rull roree and effccL n. Go-'z" ~ llcenscfJfis !L.. Lie. #I ~~~~O~~Jtit;~~~E-2S1;o Date WI/(/.. ;Z COnlra~lOr 'I~P"-5'
w , ARCHITECTS DECLA ATION ~ I undcTslanu my plan5 shall he used as puhlic record!':
u
t; Liccnsed Prnfcssional
,.., OWNER·BUILDER DECLARATION '"I hereby affirm that J am exempl from the Contractor's License Law for the ::;; o [oUowing ~ason. (Section 1031.5. Business and PruCcssiuns Code: Any city or eQURl)' e: which requires a pennit to construct, aller, improve. demolish. or repair any Slruclurc
CITY OF CUPERTINO
BUILDING DIVISION PERMIT
BUILDIN,Q AD...p!3<ESS: PERMIT NO. 1u2~~ BRITTANY CT DREAM HOME BUILDERS 06090063
OWNER'S NAME: PERMIT ISSUE DATE
13675 LONG RIDGE RD 05 11 2007
PHONE: SANITARY NO. CONTROL NO.
ARCHITECT/ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECHADD 8X18' PORCH WITH ROOF
c:::::J c:::::J c::=J c::=J
~~~~-~~~~~-=~~~~l~ha~~~-~-------S-q-.~F~t-.~F=lo-o-r-A~r-e-a-------T--------~V~a~lu-a-t~l·O-n--------
-< thal he is licl:nscd pursuanl to lhe provisions of lhe Contractor's License law (Chapler 9 ~ (commencing wilh Seclion 7(00) of Divi.c;ion 3 of the Business and ProCessions Code} or
gQ thal he is exempt therefrom and lite basis for lhr: alleged exemption. Any violation or ~bmlj~~--~a~~~-~~-~a_~~~~-------M==N~N~u-m~b~e-r-------+-------O~C-c-u-p-a-n-c-y~T=y~p-e------
not more than five hundred dollars ($500).
o 1. as owner of the property. or my employees wilh wages as lheir sole compensation.willdo~~~wd~S~~~OOli~~M~~~~C~.~.B~n~~--------------------'--d~I----------------------
and Professions Code: The Con""clor's License Law docs nol apply 10 an owner of .. ReqUIre nsp'ections
property who builds or improves thereon, and who does such work himself or through his
own employees. provided that such improvcmenlS are nol intended or offered for sale. If.
however, the Duilding or improvement is sold within One year of completion. the owner-
builder will have the burden of proving that he did flat build or improve for purpose of
sale.).
o I. as owner of !.he prope:ny. am exclusively contracting with licensed conlr8CtOrs to
conSlJUc( the project (Sec. 7044. Busine.u and Professions Code:) The Conlr.lClor's Li·
cense Law docs not apply to an owner of property who builds or improves lhercon. and .
who ContnlclS for such projects wi!.h a contractor(s) licensed pursuant to the Contractor's
License Law.
D I am ~p::.t~un
::lu/()Z
DECLARATION+ •
I hereby affirm under ~nally of ~ljury one of the following declarations:
o I hi.~ and will mainlain a Cc:rtificale of Ccmscnt to sclf~insl1re for Worker's Compen
sation, as provided for by Section 3700 or the Labor Code. for the ~rformance of the
work. for which this permit is issued.
o I have ilJld will maintain Worker's Compensation Insurance, as required by Section
3700 of the Labor Code, for the performance of the work for which this permit is issued.
My Worker's Compensation Insurance carrier and Policy number are:
C.rrier: Policy No.,.-:-:===-=-__
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
("Thu section need no! be completed if Ihe pennit is for one hundn:d doJJars ($ J(0)
or less.)
] certify !hal in Ihc perfonnancc of lhc work for which this pennil is issued. I shaJJ not
employ any person in any m "eli a come SUbject to the Workers' Compensation
Laws of California. Dale
Applicanl
NOTICE TO APPUCANT: If, afler making !his Certilicate of Exemplion. you should
become subjecl to Lhe Worker's Compensation provisions of the Lahor Code, you must
forthwith comply wilh such provisions or this permit shall be dee:med revoked.
CONSTRUCTlON LENDING AGENCY
I he:reby affirm thai there is a eonslruction lending agency ror the performance: or
the work for which this pennit is issue:d (Sec. 3097, Civ. C.)Lender's Name _
Lender's Address _
I certify that I have read this application and Slate that the above infonnatiun is
correcl I agree Lo comply with all city and county onJinances and stale laws relating to
building conslrUction, and hereby aothori7.e represcnlalivcs of lhis city [0 enler upon thc
ahovc:~mcntiuned property ror inspccLion purposes.
(We) agree to save, indemnify and kcep harmless the: City of Cupertino against
liabililies,judgmenLs, cosu and expenses which may in any way accrue against said City
Signature of Applicant! ntractor
DOUS MATERIALS DISCLOSURE
Will the applicant or future bUilding occupant store or handle hazardous malerial
as delined by the Cu~rtino Municipal Code. Chapter 9.11, and !he Health and SafelY
Code. Section 15531(0)7 • .......-
DYes !¥No
Will the applicant or fULure building occupanl usc equipment or devices which
emil hazardous air contaminanu as defined by lhe Bay Area Air Quality Management
District?
DYes ~
Date 5,.. 1((.,'"'7Issued by:
Re-roofs
Type of Roof
All roofs shall be inspected prior to any roofing material being installed.
If a roof is installed without first obtaining an inspection, I agree to remove
all ne materials D r inspection.
Signature of Applicant Date
All roof coverings to be Class "B" or better